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Thrombocytopenic purpura as initial manifestation of systemic lupus erythematosus
M Mestanza-Peralta1, R Ariza-Ariza, M H Cardiel
1Department of Immunology and Rheumatology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
Objective:
To study the outcome of patients with idiopathic thrombocytopenic purpura (ITP) treated with splenectomy, with respect to the development of systemic lupus erythematosus (SLE).
Methods:
Two independent observers reviewed data of 20 clinical, laboratory, and therapeutic variables of patients with ITP, with no clinical or laboratory indications of SLE, who were treated by splenectomy from 1952 to August 1995. 115 patients were studied, 86 female, 25 male, mean age 31.5 (SD 15.4) yrs (range 10-75), who had a mean followup of 7.2 (SD 7.5) yrs (range 0.08-32.8).
Results:
14 patients (12.1%) developed SLE. The most common SLE manifestations were arthritis (78.5%), lymphopenia (74.1%), mucocutaneous manifestations (64.2%), and hemolytic anemia (35.7%). Mortality was greater in the SLE group than in the ITP group (3 vs 4; odds ratio 6.61, 95% confidence interval 1.57-27.76, p = 0.037). 67% of the patients with ITP and 57.2% with SLE were in complete remission at the last visit (p = 0.54).
Conclusion:
Almost one of 8 patients with splenectomy due to ITP developed SLE. These patients require periodic followup to monitor other clinical data of SLE.